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NPI Code Detail

MEDICARE: JONATHAN BURNS

MEDICARE: JONATHAN BURNS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist18003393AIN

General Provider Information

NPI Number : 1568679132
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN BURNS
Provider Business Mailing Address
First Line : 9010 MICHIGAN RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-3184
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9010 MICHIGAN RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-3184
Country : US
Telephone Number : 317-532-1606
Fax Number : 317-532-1632
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 07/08/2007

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Directions to “ JONATHAN BURNS ” Practice Location

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